So I was surprised the other day when I went to the delivery of a mother with GBS in her birth canal to find that she had been treated the night before with two doses of penicillin but then, rather than continuing it until delivery, the obstetrician stopped it, for no good reason. When I found that out in the delivery room I wanted to say "Why would you do a stupid thing like that?" but decided that wouldn't be too professional.
A few minutes later I heard from another obstetrician that the obstetrician in the above case doesn't believe in treating GBS positive women until delivery with antibiotics, seeming to think that the whole thing is a little silly and that two doses are enough. This practice on her part is - how can I put this delicately - absolutely boneheaded. There are some areas in medicine where proper treatment is controversial and different options can be within the standard of care, but this isn't one of them. The Centers for Disease Control, the American College of Obstetrics and Gynecology, and the American Academy of Pediatrics all have official statements and guidelines saying the same thing, that these women should be treated with antibiotics until delivery. It's straight forward, uncomplicated, evidence based medicine. To ignore the guidelines is to invite malpractice suits; should one of the babies develop GBS infection, she might as well just write a blank check to the parents.
I'm not sure why this OB doesn't follow the guidelines. It's hard to believe she is ignorant of them, because it is such a common thing. Also, in other ways she is a consientious obstetrician. Now, though, I have to decide what to do about it. The easiest thing for me would be to refer the case to the OB Quality Assurance committee and let them handle it. That seems a bit heavy handed, though, and I wonder if I should just take the OB aside and talk to her, friend to friend, making sure she knows the guidelines and telling her she should follow them.
But I don't think it will make any difference. For one thing, I can't really say I'm friends with her; she's a bit prickly and doesn't seem to have many friends. Also, she's got a reputation for being a little stubborn. Official guidance from the QA committee might be more likely to change her practices - and keep a baby from getting infected.